Maggie Walsh-Cotton, LMT, CLT, MLD-C
Call for an Appointment 937-478-9038
Lymphatic Request for New Clients
This form is required before your first Lymphatic appointment can be made.
Once submitted, a therapist will contact you to complete the booking process.
Why are you seeking Lymphatic Therapy?
If this is for post-op procedures, please provide following:
- any complications, issues or concerns.
Physician's Name and Contact Information whom has cleared you to receive Lymphatic Therapy
Please answer as specific as you can, generalized answers or an incomplete form will not be accepted, as this will help determine your eligibility to receive Lymphatic work at our facility.